Indian Journal of Obstetrics and Gynecology Research

332-337

Authors: Savita Rani Singhal, Bhupali Das.

Vitamin D deficiency has been linked with various adverse health outcomes as a result of which it attracts the attention in research field in current days. In this way, Vitamin D deficiency has influenced upon adverse pregnancy outcomes. Over the last decade studies have been done with systematic reviews and meta analysis in epidemiologic literature. (1,2) Likewise, it is gaining importance over its classical action in health in recent era as it has some non-classical actions such as immunomodulation, anti-inflammatory, insulin secretion enhancement etc.

343-349

Authors: Amira Mohammed Badawy.

Introduction and Objectives: Endometrial cancer is the most common malignancy of the female genital tract in the world. The lymphatic spread is the most frequent pathway for spread. It primarily involves the pelvic lymph nodes. It was suggested recently that tumour size (TS) may be a risk factor for lymph node (LN) metastases. The aim of the present study was to assess the relationship between tumour size and pelvic lymph node metastasis in patients undergoing surgical staging for type-1 (endometrioid) endometrial adenocarcinoma, in order to plan for proper surgical approach. Patients and Method: A total of 29 patients with type I (endometrioid) endometrial adenocarcinoma, were included. TS was obtained through detailed ultrasound (U/S). It was defined as the largest of the three dimensions of the tumour. All cases were subjected to total hysterectomy with bilateral salpingo-oophorectomy & bilateral pelvic lymphadenectomy. TS was re-assessed pathologically. The main outcome was to assess the relation between TS (by ultrasound and by pathologically) and LN metastasis. Correlation between TS and other prognostic factors such as grade, stage, and lympho-vascular space involvement, were also studied as secondary outcomes. Results: Tumour sizes by U/S and by gross pathologic examination were significantly related to LN metastasis (p=0.009 and 0.011 respectively). There was agreement between TS measured by U/S and by pathologic examinations, (ICC) = 0.975 (95% CI 0.946-0.988) (F=39.376, p=0.000*)). The TS measured by U/S was a statistically significant discriminator of LN metastasis (AUC = 0.867 (95% CI 0.689-0.964) (Z=3.810, p=0.0001)), with a cut off value of 4.50 cm (sensitivity=80.00%, specificity=79.17%, PPV=44.4% and NPV=95.0%). Similarly, the TZ measured by pathology was also statistically significant discriminator of LN metastasis (AUC=0.858 (95% CI 0.679-0.959) (Z=3.346, p=0.0008)), with a cut off value of 5.00 cm (sensitivity=80%, specificity=91.67%, PPV=66.7%, NPV=95.7%). Conclusions: Assessment of TS by U/S and by pathologic examination are comparable in cases of type I (endometrioid) endometrial adenocarcinoma. Both methods are reliable in predicting pelvic LN metastasis with a cut off value of 4.5 cm and 5 cm respectively. Preoperative assessment by U/S is more practical and useful in planning the extent of surgery and the need for pelvic lymphadenectomy.

356-358

Authors: Divya B, Ashwini Nayak U, Sridhar Honnappa.

Introduction: Cervical cancer is the most common cancer among females in the developing countries. HPV virus plays vital role in cervical carcinogenesis. p53 inactivation plays a key role in etiology of cervical cancer. Various screening methodologies have been developed for early detection of cervical carcinoma. Recently many biomarkers have been used for diagnostic and prognostic purpose in carcinoma cervix. p53 expression can be used as a marker for the aggressive behaviour of tumor. Objectives: To compare the expression of p53 in inflammatory lesions of cervix and mild cervical dysplasia Materials and Method: Patients coming to the institution who are undergoing biopsy for abnormal cytology/colposcopy during the study period of July 2015to July 2016 are included in the study. Total of 20 patients were studied. Immunohistochemistry was used to study the p53 expression in inflammatory cervicitis and mild dysplasia of cervical epithelium Results: Out of 20 patients studied, p53 expression is found to be significant in CIN1 lesions (p value- 0.000). p53 positivity was found in CIN 1 in 38.5%(5/7) cases and negative in all cases of non- specific cervicitis Conclusion: In the present study, p53 expression was absent in inflammatory lesions and positivity was found in CIN1 lesions. This helps in identifying the subset of dysplastic lesions which need to be followed up more vigilantly to prevent their development into cancers. This could also be used as a backup for histopathology and also in cytology when there is ambiguity in knowing whether there is dysplasia or not.

364-368

Authors: Hanumant V. Nipanal, Susmitha Shivanna Reddy, Dilip Kumar Maurrya, Ravindra Pattanashetti Nagendra.

Purpose of the study: The gold standard 24-hour urine collection method for protein estimation is inconvenient and is associated with a delay in laboratory analysis. This study was undertaken to analyse the salphosalicylic acid test, urine dip stick test, urine protein to creatinine ratio with 24-hour urine protein estimation in pre-eclampsia cases. Materials and Method: This is a comparative study and consists of a single group of 240 subjects. This study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Biochemistry, JIPMER, Pondicherry, India, from February 2011 to January 2014. The subjects included 240 pre-eclampsia women. A first voided morning sample was obtained for sulphosalicylic acid test, Dipstick test, urine protein and creatinine estimation, urine culture and Subsequent urine samples were collected for the 24-hour urine protein estimation. Main findings: For significant proteinuria sulphosalicylic acid test with 1+ proteinuria has sensitivity, specificity, PPV, NPV of 59%,48%,39%,67% where as 2+ has 44%, 88%, 75% and 67% respectively, dipstick test with 1+ proteinuria has sensitivity, specificity, PPV, NPV of 71%, 52%, 54%,70% where as 2+ has 49%, 87%, 75% and 69% respectively. The spot urine protein to creatinine ratio and 24-hour urine protein were significantly correlated (r=0.98; P<0.0001). The cut-off value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285. The sensitivity, specificity PPV and NPV were 100%, 99.02%, 100% and 99% respectively. Conclusion: The spot urine protein to creatinine ratio is a better method for estimation of proteinuria in pre-eclampsia. Funding: No Funding body, corresponding author himself bear the necessary expenses.

373-375

Authors: Rashmi Naganagoudaru, Vinaya Goudar.

Postpartum hemorrhage accounts for > 25% of deaths, an effective treatment for postpartum hemorrhage (PPH) would contribute importantly to the Millennium Development Goal of decreasing maternal mortality. Objective: To observe whether the antifibrinolytic agent, tranexamic acid reduces maternal mortality, need of hysterectomy in women with diagnosed postpartum hemorrhage and to evaluate adverse drug reaction of tranexamic acid. Materials and Method: This study was conducted at Department of OBG, Karnataka Institute of Medical Sciences(KIMS) Hubli during May 2010 to April 2011. Hundreds women who has been diagnosed PPH were included in the study. Patients were allocated into two groups: Control group (fifty case) and Study group (fifty case). To collect and quantify amount of collected blood, BRASS-V˶ drape was used. Numbers and cause of maternal mortality was evaluated. Surgical intervention or hysterectomy required for failed medical management, and maternal side effects caused by tranexamic acid were noted. Results: Both groups are comparable with regards to, age, parity distribution, type of delivery, causes of PPH (p-value> 0.05). Mean blood loss in control group was 744±102ml while that in tranexamic acid group was 626±113ml this difference between the two groups was highly significant (p value<0.0001). Hence in terms of blood loss tranexamic acid group is more efficacious when compared to control group. There was no maternal mortality due to failure of treatment of post partum hemorrhage in both the groups. None of patients needed surgical intervention or hysterectomy for failed medical treatment of PPH. In two groups side effect like thrombosis is not seen either in control group or tranexamic acid group. Conclusion: Tranexamic acid significantly reduced the blood loss and maternal morbidity and mortality in patients with post partum haemorrhage.

381-383

Authors: Arul Anne Rose S, Beulah Edwin, I. Kannan

Aim: To estimate the prevalence of bacterial vaginosis in preterm labour patients when compared to term labour patients. Materials and Method: It was a hospital based prospective case-control study conducted over a period of two years. Study population was selected as per our study criteria. Speculum examination was done for both control and cases and evaluated for any abnormal vaginal discharge and vaginal pH. Smear from posterior fornix was taken using sterile cotton swabs for wet mount and KOH test (Whiff test). Diagnosis of bacterial vaginosis was made if three of the four signs of Amsel criteria were found. The data were analysed using SPSS software 20 and results were derived. Results: Among the patients bacterial vaginosis was present in 24 of the preterm labour (26.7%) patients and 5 of the term labour (5.6%) patients (Table 1). It was statistically significant (p < 0.001) by Chi-square test. Considering the relative risk(RR), women with bacterial vaginosis has increased risk of preterm labour when compared to patients without bacterial vaginosis(Odds ratio -6.182;RR-4.800). Conclusion: Our study concluded that bacterial vaginosis is one of the most important causes of preterm labour. Routine screening and treatment of bacterial vaginosis for women at high risk for preterm labour will help in reduction of preterm birth related perinatal morbidity and mortality.

389-391

Authors: P. Thulasi, Balakrishnan R, Shanthi M.

Objective of the study is to compare the safety and efficacy of oral versus vaginal misoprostol 25mcg for induction of labour at term and to assess perinatal out come. Materials and Method: Study was conducted in the department of Obstetrics and Gynecology (OBG) at P K Das Institute of Medical Sciences, Vaniamkulam. It was a one year study. It is a comparative prospective study on 300 patients admitted at term for safe confinement. The patients were divided into 2 groups – 150 in each – 25 mcg oral misoprostol / 25mcg vaginal. Results: There is no statistically significant association between parity and route of administration of drug. There is statistically significant association between Premature Rupture of Membranes (PROM) and route of administration of drug. In oral group- 66.6 % had Induction Delivery interval between 8-12 hrs and in vaginal group – 68% had Induction Delivery interval between 8-12hrs. In oral group - 100 % had 2 repeat doses. In vaginal group - 90% had 2 repeat doses. In oral group, 80% had normal delivery. Only 6.66% had LSCS. In vaginal group, 73.33% had normal delivery. 13.33% had LSCS. In oral group, 96.66% had no NICU admission. In vaginal group, 97.33% had no NICU admission. Among the oral group of those patients who had atonic Post Partum Hemorrhage (PPH), three required blood transfusions. Conclusion: In our study, oral misoprostol 25mcg is as effective as vaginal misoprostol 25mcg for induction of labour at term with minimal maternal and fetal complications.

395-398

Authors: Harsha Ramdurg.

Introduction: Cardiac disease in the pregnant patient can present challenges in cardiovascular and maternal-fetal management. The present study is a retrospective analysis of the cases treated at our institute of heart disease in pregnancy. Objectives: The study was conducted to study the epidemiological, clinical and outcomes in patients of cardiac illness in pregnancy Materials and Method: All pregnant patients of cardiac illness were admitted to the institute from 2015 to 2016 were studied. Data was collected from patient records operative notes and discharge summaries. Results: 80 institutional deliveries were conducted in the above time period. Five cases cases of heart diseases complicating pregnancy were studied:2 cases of peripartum cardiomyopathy, one each of aortic stenosis, pulmonary stenosis and mitral stenosis with mitral regurgitation. However, one patient of peripartum cardiomyopathy patient was excluded as the patient was brought in an unconscious condition with poor Glassgow coma scale and on ventilator support and relatives declined treatment and was lost to follow up. All the other patients had satisfactory outcome. Conclusion: Early identification of the cardiac lesions can lead to effective and safer delivery at places where advanced care is available.

404-406

Authors: Kala Katti, Anupama Rani V, Umashankar KM, Dharmavijaya MN.

Introduction and Objectives: The present study was done to determine the total number of antepartum and intrapartum fetal deaths; to know the probable etiology and management of the same, and to study the role of antenatal care in prevention of IUFD. Materials and Method: A prospective study of intrauterine fetal demise and associated maternal factors were studied. All IUFD with singleton pregnancies more than 28 weeks of gestation were included in the study. Results: The fetal death rate was 25.4 1000 births. Major causes of IUFD were PE and eclampsia (36.19%) and abruption placenta (19.87%). Majority were preterm (56.31%) and birth weight 2.5 kg (72.17%). Risk of IUFD was significantly less in booked patients than in unbooked patients. Conclusion: Present study showed that majority of IUDs were preventable. Early detection of pre-eclampsia by regular ANCs and its treatment can reduce its complications including IUD and abruption placenta in few cases thereby further reducing the stillbirth rate.

416-419

Authors: GN Vasanthalakshmi, SR Subasri, Priyadharshini K

Introduction: Intra uterine contraceptive device is an effective, reversible and long term method of contraception. The device is made of poly ethylene which is impregnated with barium sulphate to render it radio opaque so that the presence or absence of the device in the pelvis can be easily detected by radiograph or ultrasound. Each device has nylon thread attached to its lower end and this thread protrudes through the cervical canal into vagina. It does not require replacement for long periods. IUCD s have rare but endangering side effects such as uterine perforation.(1) Missing IUCDs may be asymptomatic or present with symptoms. It could be intrauterine, partially embedded in the cavity or extrauterine. Nowadays due to advent of hystero laparoscopy, many of the cases of missing IUCD s are managed easily.(2) Objective: To study the management of misplaced intra uterine device. Materials and Method: It is a Retrospective observational study conducted at a tertiary care hospital from June 2015 to June 2017 for 2 years. Results: In the review of 37 patients with missing IUCD threads, 12 (32.4%) were removed by simple curettage or using IUCD hook under ultrasound guidance, 21 (56.7%) were removed under hysteroscopic guidance, 1 (2.7%) was removed by laparoscopy and 3 (8.1%) were removed by laparotomy. Conclusion: Most of post placental insertion of IUCD s were embedded into uterine myometrium or perforated the uterus and required either endoscopy or laparotomy for removal.

424-426

Authors: Ambika HE, Swathi Bhat, Lepakshi BG, Savitha CS.

Objective: To evaluate risk factors, incidence, indication, maternal and fetal outcome in patients undergoing emergency obstetric hysterectomy in a tertiary care center. Materials and Method: It is a retrospective study of 40 cases in a tertiary referral teaching Hospital. All women who underwent Emergency obstetric Hysterectomy between Jan 2010 to Dec 2015 were included in the study conducted in the Department of obstetrics and gynecology, Shivamogga Institute of Medical Sciences, Shivamogga. The total number of deliveries during the study period was 48,102. Results: 40 women underwent emergency obstetric Hysterectomy (0.083%) during the study period. Out of these, 12 women had vaginal delivery and 28 were delivered by caesarean section. 3women were grand multipara and 8 were primipara. Majority of the women who underwent Emergency Obstetric Hysterectomy were second gravida. Atonic PPH, Adherent placenta, Rupture uterus, placenta previa, post B- Lynch uterine sepsis were the indications for Emergency obstetric Hysterectomy. All the women were admitted to the ICU for post operative care. Conclusion: Emergency obstetric Hysterectomy is indeed a life saving procedure when used judiciously especially when patient fails to respond to medical line of management.

432-436

Authors: Meena Shantanu Gunjotikar, Karande Suryaprakash J.

Introduction: The diagnosis of cervical incompetence is often retrospective. It has become one of the obstetric challenges because of the lack of uniform prospective diagnostic criteria. Ultrasonography is an invaluable aid in the diagnosis of cervical incompetence as it is safe and noninvasive. The present study focused on changes in cervical parameters and relationship of cervical parameters with pregnancy outcome. Materials and Method: Total 160 cases - primigravidas were studied for the ultrasonographic parameters of cervix during the study period. Institutional Ethical committee approval was taken before beginning of the study. Patient were subjected to ultrasonographic study between 14 to 22 weeks for the first time, then serial ultrasonography was done monthly mainly for cervical parameters and if required, cervical encerclage was done. Result: The incidence of cervical incompetence found in the present study was 1.25%. Mean cervical length was 3.49±0.53cm and mean diameter of internal os was 3.75 ±1.5mm. Shorter the cervical length, lesser is the gestational age at the time of delivery. Conclusion: We conclude that, cervical length and diameter of internal OS are very important cervical parameters for the cervical incompetence.

440-445

Authors: Ashish Raj Kulshrestha, Rupita Kulshrestha, Manish Raj Kulshrestha.

To analyze the pattern of occurrence of female genital tract (FGT) cancers at a tertiary care centre in Northern India in last one decade (2007-2016). In this retrospective study, data was collected for the past 10 years from department of radiotherapy KGMU, Lucknow and analyzed with SPSS software. A total of 30,705 patients with malignancy were registered, 13,482 (43.91%) were females, of which 5717 (18.62%) were diagnosed with female genital tract cancers. The trend shows that the number of patients presenting with FGT cancers had been doubled in 2016 comparison to that in 2007, though the proportion of FGT cancers out of patients presenting with any malignancy remain similar. Cancer cervix is the major bulk followed by cancer ovary and cancer endometrium. Cancer vulva and vagina are less common but their number is also increasing every year. On average, FGT cancers represent one fifth of all malignancies and one half of all malignancies in females with no significant rise in presentation throughout last ten years. Increasing awareness for FGT malignancies is the need of hour.

453-454

Authors: Keshav Ram, Rama Thakur, Anshul Sonkhla, Kapil Dev.

Lymphoepithelioma-like carcinoma of the cervix is a variant of squamous cell carcinoma. Of all cervical cancer it comprises about 0.7% cases. It differs from the usual squamous cell carcinoma of cervix in its clinical behaviour, morphology and has a better outcome. We report two cases of Lymphoepithelioma-like carcinoma of cervix associated with Human Papilloma Virus-16 in Indian women. They were staged as FIGO Ib1 and Ib2 respectively, and a radical hysterectomy was performed.

458-459

Authors: Neha Varun, Arifa A. Elahi, Aruna Nigam, Nidhi Gupta

Leiomyomas are the most common benign tumors of the uterus, but parasitic fibroid is a rare entity. A parasitic leiomyoma is a type of extra-uterine leiomyoma and presents as pelvic benign smooth-muscle masses separate from the uterus. It originates from pedunculated subserosal leiomyoma that twists and torses from its uterine pedicle and thus the contact between the mass and the uterus is lost. A case of parasitic leiomyoma presenting as an adnexal mass in pregnant female causing obstructed labour is reported. 25 year old primigravida with term pregnancy had an emergency lower segment caesarean section (LSCS) in view of arrest of descent of head (mechanical obstruction). Emergency LSCS revealed B/L hard adnexal masses attached to the ovary. Both the masses were removed and histopathological findings were suggestive of leiomyoma. Parasitic leiomyoma presenting an adnexal mass in pregnant female causing obstructed labour is a rare case presentation with no prior history of any Laparoscopic morcellation procedures or myomectomy.

4707-410

Authors: Vijayalakshmi Cooly, Sailaja Bandaru, Bhuvaneswari Salicheemala, Jithendra Kandati, Mohanrao Nandam

Introduction: Infertility is becoming an increasing concern in both developed and developing countries. However most of the studies mention variable differences in the prevalence of infertility, as it is known to differ from place to place and region to region globally. Semen analysis remains the most basic and simple test for evaluation of male infertility which is also inexpensive and can provide valuable information. Therefore, evaluation of semen parameters may provide an insight into the diagnosis of male infertility. Objectives: The study was done mainly to assess the risk factors of male infertility and also to identify the contribution of male infertility in infertile couples. Materials and Method: A prospective study was conducted among 400 couples attending infertility clinic and seminal analysis was conducted among the male partners of the study as per WHO guidelines 2010. The demographic data, risk factors of the male partners with abnormal seminal parameters are collected by interviewing and noted. Statistical analysis was done by using SPSS version 10. Results: Incidence of male infertility in the study was 36% and the most common age group was 26-30 years with mean age of 34± 2.6 years, mean duration of marriage life was 3.8± 2.40 years. 61.11% of cases were exposed to occupational risk factors like driving, baker industry etc. Smoking, varicocele and past H/O urogenital tract infections were considered statistically significant factors in cases of male infertility. Oligozoospermia (50%) followed by Asthenozoospermia (38.9%) were common causes of male infertility. Discussion: The pattern and causes of male infertility vary from place to place and among different regions. In our study the prevalence of male infertility was 36%. Smoking is known to have negative effects on sperm quantity, quality and morphology. Our findings were in accordance with many studies that showed smoking drastically reduces sperm motility and quality. To conclude, there is an increasing trend of male infertility in India when compared to previous years of studies. Hence studies and measures should be directed towards factors which are causing an alarmingly increasing rise in male infertility and attempts should be directed to control the causes in near future.